Transitional cell tumours of the lacrimal drainage apparatus

BACKGROUND

Tumours of the lacrimal drainage apparatus (LDA) are very rare, but can be life-threatening. Seventy percent of lacrimal sac tumours are of epithelial origin, and transitional cell tumours represent an interesting sub-group of these epithelial tumours.

METHODS

A retrospective review of cases of LDA transitional cell tumours co-managed at the Royal National Throat Nose and Ear Hospital and Moorfields Eye Hospital, London.

RESULTS

Twenty cases of transitional cell tumours of the LDA were identified, comprising 10 transitional cell papillomas (TCPs) and 10 transitional cell carcinomas (TCCs). All cases were resected through a modified lateral rhinotomy approach. Limited resection of orbital fat with preservation of orbital functions was required for 2 cases of TCC. Fractionated external beam radiotherapy was administered in 7 cases of TCC. The mean follow up was 80 months (range 11 months-16 years). Recurrences were detected in 4 cases, which were managed by further surgery. Two cases have been lost to follow-up, but the 18 other patients are currently alive and disease free.

CONCLUSION

A favourable outcome can be achieved with transitional cell tumours of the LDA when an optimum management plan is followed.

Merino ewes can be bred for body weight change to be more tolerant to uncertain feed supply

Sheep in Australia experience periods with different feed supply causing them to gain and lose BW during the year. It is more efficient if ewes lose less BW during periods of poor nutrition and gain more BW during periods of good nutrition. We investigated whether BW loss during periods of poor nutrition and BW gain during periods of good nutrition are genetically different traits. We used BW measurements from 2,336 adult Merino ewes managed over 5 yr in a Mediterranean climate in Katanning, Australia. Body weight loss is the difference between 2 BW measured 42 d apart during mating, a period of poor nutrition. Body weight gain is the difference between 2 BW measured 131 d apart during a period of good nutrition between prelambing and weaning. We estimated variance compnents of BW change using 3 methods: 1) as a trait calculated by subtracting the first BW from the second, 2) multivariate analysis of BW traits, and 3) random regression analysis of BW. The h(2) and genetic correlations (rg) estimated using the multivariate analysis of BW and the BW change trait were very similar whereas the random regression analysis estimated lower heritabilities and more extreme negative genetic correlations between BW loss and gain. The multivariate model fitted the data better than random regression based on Akaike and Bayesian information criterion so we considered the results of the multivariate model to be more reliable. The heritability of BW loss (h(2) = 0.05-0.16) was smaller than that of BW gain (h(2) = 0.14-0.37). Body weight loss and gain can be bred for independently at 2 and 4 yr of age (rg = 0.03 and -0.04) whereas at 3 yr of age ewes that genetically lost more BW gained more BW (rg = -0.41). Body weight loss is genetically not the same trait at different ages (rg range 0.13-0.39). Body weight gain at age 3 yr is genetically the same trait at age 4 yr (rg = 0.99) but is different between age 2 yr and the older ages (rg = 0.53 and 0.51). These results suggest that as the ewes reach their mature BW, BW gain at different ages becomes the same trait. This does not apply to BW loss. We conclude that BW change could be included in breeding programs to breed adult Merino ewes that are more tolerant to variation in feed supply.

Outcome of laparoscopy-assisted feeding tube insertion in elderly stroke victims

BACKGROUND

When percutaneous endoscopic gastrostomy (PEG) is not possible, or fails, the patient is referred for laparoscopic gastrostomy or jejunostomy (LAG/J).

METHOD

During 2005-2008, we performed laparoscopy-assisted feeding tube insertion on 15 patients. We assessed the outcome in terms of leaks, infection, longevity etc. The patients were followed-up for up to 12 months.

RESULTS

The procedure was successful in 14/15 patients. However, thirteen died within little more than a year, of whom seven suffered from pneumonia or aspiration.

DISCUSSION

Our study confirms that LAG/J is technically possible, carries a high morbidity, is a last ditch attempt and that it does not change the general prognosis of these debilitated patients.

Age and nutrition influence the concentrations of three branched chain fatty acids in sheep fat from Australian abattoirs

The characteristic mutton odour, associated with the cooked meat of older sheep, can be problematic for some consumers who find the odour disagreeable. Branch chain fatty acids (BCFAs) are considered to be the main determinants of mutton odour. In this study, the aim was to identify the factors influencing the BCFA content of animals at abattoirs in Australia. Samples of subcutaneous fat from over the chump (gluteus medius) were collected from 533 sheep carcasses at abattoirs in New South Wales, Victoria and Western Australia. The carcasses were from sheep differing in age, gender, breed and nutrition. The concentrations of three branched chain fatty acids (BCFAs); namely, 4-methyloctanoic (MOA), 4-ethyloctanoic (EOA) and 4-methylnonanoic acids (MNA), were determined. Statistical modelling showed that, with pre-slaughter nutrition in the model as a random term, BCFA concentrations could be used for discriminating the age of sheep. Fat samples from lamb carcasses had lower MOA and EOA concentrations and a higher concentration of MNA in comparison to hogget and mutton (P<0.05). When nutrition was excluded as a random effect from the statistical model, the MOA and MNA concentrations did not differentiate between lamb, hogget and mutton whereas, for EOA, lamb had a lower concentration than mutton (P<0.05) with hogget intermediate. An interaction existed between age and gender (P<0.05) where female lambs had lower EOA concentrations relative to the mutton but not for castrates.

Factors influencing Australian community pharmacists' willingness to participate in research projects - an exploratory study

Objective

To identify the factors influencing Australian community pharmacists' willingness to participate in research projects and their attitudes towards research.

Method

A mixed-method survey instrument comprising demographics, previous participation in research, and perceptions about participation in research was mailed to 267 community pharmacists in New South Wales and the Australian Capital Territory. An analysis of variance test was used to identify similarities and differences between research- and non-research-active respondents. Bivariate correlations and partial least squares (PLS) regression analyses were used to identify barriers and facilitators to research participation.

Key findings

The overall response rate to the survey was 40%. Of these, 70% were classified as previous research participants (PRP), and 30% were classified as non-previous research participants (NPRP). Both groups had mostly favourable attitudes towards research; however, the results revealed several differences between the PRP and NPRP groups. Three items were identified as key facilitators to participation in research for both PRP and NPRP groups - having an interest in the research topic; believing that the research will benefit the customer; and a belief that community pharmacy research is important. Lack of time, either real or perceived, was identified as a key barrier to participation in research for both the PRP and NPRP groups.

Conclusion

Researchers should take into account pharmacists' previous research experience when recruiting pharmacists into research projects. In the case of pharmacists with research experience, emphasis should be on promoting factors that facilitate participation. In the case of pharmacists with little research experience, emphasis should be on reducing barriers to participation.

[Telemedicine in acute stroke care--a health economics view]

Specialized stroke units offer optimal treatment of patients with an acute stroke. Unfortunately, their installation is limited by an acute lack of experienced neurologists and the small number of stroke patients in sparsely populated rural areas. This problem is increasingly being solved by the use of telemedicine, so that neurological expertise is made available to basic and regular care. It has been demonstrated by national and international pilot studies that solidly based and rapid decisions can be made by telemedicine regrading the use of thrombolysis, as the most important acute treatment, but also of other interventions. So far studies have only evaluated improvement in the quality of care achieved by networking, but not of any lasting effect on any economic benefit. Complementary to a medical evaluation, the qualitative economic assessment presented here of German and American concepts of telemetric care indicate no difference in efficacy between various ways of networking. Most noteworthy, when comparing two large American and German studies, is the difference in their priorities. While the American networks achieved targeted improvements in efficacy of care that go beyond the immediate wishes of the doctors involved, this was of only secondary importance in the German studies. Also, in contrast to several American networks, the German telemetry networks have not tended to be organized for future growth. In terms of economic benefits, decentralized organized networks offer a greater potential of efficacy than purely local ones. Furthermore, the integration of inducements into the design of business models is a fundamental factor for achieving successful and lasting existence, especially within a highly competitive market.

Sheep category can be classified using machine learning techniques applied to fatty acid profiles derivatised as trimethylsilyl esters

Eruption of permanent incisors (dentition) is used as a proxy for age for defining meat quality in Australian sheep meat. However, this approach may not be reliable. While not presently available, an objective method could be used to determine sheep age, and thus sheep category, which would then potentially remove any inaccuracies that may occur in classifying sheep meat product. Statistical classification algorithms have been successfully used in bioinformatics. In this paper we review the performance of three algorithms (support vector machines, recursive partitioning and random forests) for determining sheep age. The algorithms were applied to the measured fatty acid profiles of fat samples from 533 carcasses; 254 lamb (<1 year old), 131 hogget (~1–2 years old) and 148 mutton (>2 years old) samples. Three data pretreatments (range transformation, column mean centering and range transformation with mean centering) were also examined to determine their impact on the performance of the algorithms. The random forests algorithm, when applied to mean-centred data, gave 100% predictive accuracy when classifying sheep category. This approach could be used for the development of an objective test for determining sheep age and category.

Asthma clinic attendance improves quality of life of Jamaican asthmatic children and their parents

BACKGROUND

With the increasing incidence of paediatric asthma, there has been a corresponding increase in the physical, emotional and financial burden. This has led to a greater interest in determining the impact of asthma and its treatment on many aspects of patient functioning and wellbeing.

AIM

To assess the usefulness of the Asthma Clinic established in Jamaica in 1997 by ascertaining whether there has been improvement in quality of life of children and care-givers who attend the clinic.

METHODS

The quality of life of patients and their parents/care-givers before attending the Asthma Clinic of Bustamante Hospital for Children in Kingston, Jamaica was compared with that of 1 year afterwards. Parents or guardians were interviewed using the Pediatric Asthma Quality of Life Questionnaire which consists of three domains [symptoms (ten questions), emotional (eight questions) and activity (five questions)] and the Pediatric Asthma Caregiver's Quality of life Questionnaire which consist of two domains [emotional (nine questions) and activity (four questions)].

RESULTS

Quality of life improved in patients and their parents/care-givers in all domains.

CONCLUSION

Attendance at an asthma clinic in Jamaica improved the quality of life of asthmatic children and their parents/care-givers.

Idiopathic pustular vulvitis

A 31-year-old woman presented in the 23rd week of her third pregnancy with extremely painful pustular vulvitis, unresponsive to antibiotics. Although the histological findings were was consistent with a diagnosis of hidradenitis suppurativa (HS), bridged comedones, the hallmark of this disease, were absent and there were no dermal sinuses. Incision and drainage of the pustules provided only temporary improvement, which was briefly maintained with oral clindamycin and topical steroids. After the birth, a course of isotretinoin produced almost total clearance, a response not typically found in HS. This patient's condition may represent a variant of HS, and if so, it would be the first case report of de novo HS in pregnancy, but its clinical features and evolution differed so much from those in HS that the possibility of a previously unrecognised condition cannot be excluded.